How can I improve my incontinence problem?

Answer: Try reducing your caffeine intake.

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Curr Opin Obstet Gynecol. 2011 Oct;23(5):371-5.

Treatment of mixed urinary incontinence in women.

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Abstract

PURPOSE OF REVIEW:

Deciding on an optimal therapy for mixed urinary incontinence (MUI) is challenging, as a single-treatment modality may be inadequate for alleviating both the urge and stress component. A MEDLINE search was conducted regarding English-language literature pertaining to the treatment for MUI focusing on literature within the last 18 months.

RECENT FINDINGS:

Behavioral therapy and lifestyle modification, such as moderate weight loss and caffeine reduction, should be considered first-line options for all women with MUI. The addition of pelvic floor muscle therapy may have an additional salutary effect. Treatment of the urge component with antimuscarinics is effective; however, the stress component is likely to persist after therapy. Treatment with vaginal estrogen cream may help in the short-term, but long-term benefits are unknown. Anti-incontinence surgery may have a positive impact on both the stress and urge components of MUI; however, it appears that women with MUI may have lower cure rates compared to women with pure stress urinary incontinence.

SUMMARY:

The optimum treatment of MUI may often require multiple treatment modalities. Although surgery may often have a positive impact on both components, its routine implementation should be approached with caution and patients should be carefully selected and counseled.

What can help my incontinence problem?

Answer: Do pelvic floor muscle exercises.

A 20010 Cochrane review has definitively come out in support of the benefits of doing pelvic floor exercises for urinary incontinence problems in women:

Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women.

Abstract

BACKGROUND:

Pelvic floor muscle training is the most commonly used physical therapy treatment for women with stress urinary incontinence. It is sometimes recommended for mixed and less commonly urge urinary incontinence.

OBJECTIVES:

To determine the effects of pelvic floor muscle training for women with urinary incontinence in comparison to no treatment, placebo or sham treatments, or other inactive control treatments.

SEARCH STRATEGY:

The Cochrane Incontinence Group Specialised Trials Register (searched 18 February 2009) and the reference lists of relevant articles were searched.

SELECTION CRITERIA:

Randomised or quasi-randomised trials in women with stress, urge or mixed urinary incontinence (based on symptoms, signs, or urodynamics). One arm of the trial included pelvic floor muscle training (PFMT). Another arm was a no treatment, placebo, sham, or other inactive control treatment arm.

DATA COLLECTION AND ANALYSIS:

Trials were independently assessed for eligibility and methodological quality. Data were extracted then cross-checked. Disagreements were resolved by discussion. Data were processed as described in the Cochrane Handbook (Higgins 2008). Trials were subgrouped by diagnosis. Formal meta-analysis was not undertaken because of study heterogeneity.

MAIN RESULTS:

Fourteen trials involving 836 women (435 PFMT, 401 controls) met the inclusion criteria; twelve trials (672) contributed data to the analysis. Many studies were at moderate to high risk of bias, based on the trial reports. There was considerable variation in interventions used, study populations, and outcome measures.Women who did PFMT were more likely to report they were cured or improved than women who did not. Women who did PFMT also reported better continence specific quality of life than women who did not. PFMT women also experienced fewer incontinence episodes per day and less leakage on short office-based pad test. Of the few adverse effects reported, none were serious. The trials in stress urinary incontinent women which suggested greater benefit recommended a longer training period than the one trial in women with detrusor overactivity (urge) incontinence.

AUTHORS’ CONCLUSIONS:

The review provides support for the widespread recommendation that PFMT be included in first-line conservative management programmes for women with stress, urge, or mixed, urinary incontinence. Statistical heterogeneity reflecting variation in incontinence type, training, and outcome measurement made interpretation difficult. The treatment effect seems greater in women with stress urinary incontinence alone, who participate in a supervised PFMT programme for at least three months, but these and other uncertainties require testing in further trials.

How can I help my incontinence problem?

Answer: Try pelvic floor exercises. The video below shows you how.

Eur J Obstet Gynecol Reprod Biol. 2011 Sep 29. [Epub ahead of print]

Individual and group pelvic floor muscle training versus no treatment in female stress urinary incontinence: a randomized controlled pilot study.

Source

Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil.

Abstract

OBJECTIVE:

To compare the effects of pelvic floor muscle training (PFMT) performed during group treatment sessions (GT) and individual treatment sessions (IT) to a control group (CG) of women with stress urinary incontinence (SUI).

HYPOTHESIS:

The group treatment sessions would have better effects compared to individual treatment sessions.

STUDY DESIGN:

This randomized controlled pilot study included women aged over 18 years, who complained of urinary leakage on stress and who had not undergone physical therapy for SUI before. Forty-nine women were randomly allocated to the PFMT in group treatment session (GT) (n=17), PFMT in individual treatment session (IT) (n=17) and control group (CG) (n=15). The study was carried out in an outpatient physical therapy department in São Carlos, Brazil. Subjects on intervention groups were treated with the same PFMT protocol for 6 weeks, with two 1-h weekly sessions. The GT group carried out the PFMT in group treatment session and IT group in individual treatment session. The CG did not receive any treatment during the corresponding time. They were evaluated before and after treatment for primary outcome, urinary loss, and secondary outcomes, King’s Health Questionnaire, pressure perineometry, pelvic floor muscle strength by digital palpation and subjective satisfaction. Participants, evaluator and the physical therapist were not blinded. Forty-five women completed the study and were included in the analysis. The statistical analysis was performed using Wilcoxon test for intragroup analysis and Kruskal-Wallis and Mann-Whitney test for intergroup analysis (p<0.05).

RESULTS:

In intragroup analysis, there was a significant reduction in urinary loss measured by pad test only in the IT group. For primary outcome, there was a significant difference only after treatment between GT and CG (p<0.0001; effect size -0.91; 95% confidence interval from 0.56 to 5.80) as well as between IT and CG (p<0.0001; effect size -0.90; 95% confidence interval from 0.54 to 5.84). There were differences after treatment in GT and IT groups for secondary outcomes: perineometry, muscle strength and in the domains of the quality of life questionnaire. For the CG group, there were not significant differences in any variables. In intergroup analysis for all variables, there were no differences between GT and IT groups. The two treated groups had similar subjective satisfaction (86%). There were no complaints of adverse effects due to treatment from either group.

CONCLUSION:

The results indicated similar improvement in clinical variables and in satisfaction with the treatment between IT and GT.

How can I learn how to do pelvic floor muscle exercises properly?

1. Visit a physiotherapist who specializes in the pelvic floor for instruction.

2. Watch this video to learn what to do, and then check with a physio you are doing the exercises correctly.

From the video intro:

Expert physiotherapist practical tips and step-by-step guidelines from http://pelvicexercises.com.au. Learn how to feel your pelvic floor muscles working for correct pelvic floor training. Essential knowledge for performing pelvic floor exercises or Kegel exercises correctly.